By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
October 2018 marks the 33rd year of the national breast cancer public awareness campaign… for some of you, this means it’s time to dig your running shoes out of the closet and raise some money for a good cause. For others, it means wearing a pink ribbon to show support for and honor a friend or family member that has battled breast cancer. You, yourself, may be a brave survivor, perhaps due to National Breast Cancer Awareness Month (NBCAM) efforts. I am lucky to have a few survivors in my family, and truly believe awareness can be curative as long as you’re getting information that will truly help you.
Quick Breast Cancer Facts
According to the U.S. Centers for Disease Control and Prevention, breast cancer is the leading form of cancer affecting women and the second deadliest, after lung cancer. Breast cancer affects approximately one in every eight women and causes an estimated 40,000 deaths a year. And, although much less frequently, it also strikes men.
One troubling statistic is that black women have a 40 percent greater chance of dying from breast cancer than white women. Since reported screening efforts are about the same between black and white women, the CDC explains that black women tend to delay seeking follow up care after having a mammogram showing abnormal results, while white women tend to take quicker action.
Most cases of breast cancer are in women ages 50 and older. Being a woman, getting older, having a breast cancer gene, getting pregnant later in life or not at all, and lack of exercise are among the many risk factors listed by the CDC. Knowing risk factors is definitely important – especially where genetics are concerned – but so is living an anti-cancer lifestyle, which the CDC doesn’t really touch on except for mentioning lack of physical activity as a risk factor. Eating lots of carotenoid-rich fruits and veggies and not eating too much red meat, for example, can definitely impact your risk of developing breast cancer (more about breast cancer prevention below).
Symptoms of breast cancer include a lump in your breast or underarm, changes in the shape or size of your breast, breast pain or irritation, nipple discharge (other than breast milk), nipple pain or inversion. You can visit this CDC page for a full list of breast cancer symptoms.
The good news is that, overall, breast cancer death rates have declined over the past two decades; the American Cancer Society (ACS) attributes this to better early detection efforts. More than 2.8 million breast cancer survivors (those who have received or are receiving treatment) are estimated to be living in the U.S. today.
Controversy Over Mammogram Recommendations
The NBCAM program has shown great progress as a means of increasing public awareness about the need for early detection of breast cancer through regular self-breast exams and screening. However, NBCAM and some other organizations continue to recommend that women ages 40 and above receive annual mammograms despite controversy surrounding mammogram safety and effectiveness. Standard breast cancer screening tools, mammograms are X-rays of breasts that can help identify lumps which may be malignant tumors.
In November 2009, the United States Preventative Services Task Force (USPSTF) released recommendations about breast cancer screening based on impartial reviews of scientific evidence on the effectiveness of mammography. While USPSTF noted the existence of convincing evidence that mammography screening reduces breast cancer mortality, it found that the net benefit of such screening is much smaller for women ages 40 to 49 than for women ages 60 to 69. Reduction of net benefit in 40 to 49 year old women is due to harms associated with regular mammography screening, including “psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results.” USPSTF also noted radiation exposure as a consideration. As 40 to 49 year old women experience greater incidence of false positive results, USPSTF recommended that women ages 50 to 74 receive mammogram screening every other year.
Through “Mammograms’ Value in Cancer Fight at Issue,” New York Times reporter Gina Kolata voiced similar mammography concerns derived from study results published in late September 2010.
More recently, a 2014 Canadian study of women between the ages of 40 and 59 showed that annual mammograms did not decrease death rate due to breast cancer any more than physical examinations followed by usual care in the community.
Over this 25 year study, the women were divided into groups by age: 40 to 49 years and 50 to 59 years. All those in the 40-49 year-old group received an initial physical examination and were taught self-breast examination; this group was randomly divided into a control group, which was told to remain under the care of their family doctors, and a mammogram group, which was offered annual mammograms and physical examinations. Women between the ages of 50 and 59 were similarly divided into either an annual mammography or no mammography group; both the mammography and control groups in this age bracket, however, were offered annual physical exams. Overall, 22 percent of screen-detected invasive breast cancers were over-diagnosed in the mammography groups. The researchers suggested a reassessment of the value of mammography screening.
I must also note here that this study employed film, rather than digital, mammography. While both mammography methods utilize X-ray imaging, digital is now considered better for screening than film is, and also uses less radiation. However, radiation is still carcinogenic, and can add up year after year.
Through another 2014 (non-randomized) study published in The Journal of the American Medical Association (JAMA), though, researchers determined that adding an additional screening tool called tomosynthesis to digital mammography helped increase cancer detection rate while decreasing recall rate (proportion of patients who need additional imaging based on the initial screening exam result).
While this result, initially, sounds promising, I’m concerned about the extra carcinogenic radiation that tomosynthesis adds to the digital mammography program: it essentially doubles the dose. And while the researchers “cited excessive false-positive results, limited sensitivity, and potential for over-diagnosis” as reasons why mammography has recently drawn mainstream criticism, they made no peep about concerns over existing radiation from annual mammography exams. Again, all that radiation adds up.
What to take from these recent studies? Even though they were not offered to the younger (control) group of women in the 25-year Canadian study, annual physical breast exams and regular self-examination are good preventative strategies for women ages 35+. While most breast cancers, according to the CDC, are found in women over 50, 11 percent of cases do occur in women under 45; hence, physical check-ups at the family doctor or OBGYN are not unnecessary for younger women every few years, in my book. Get checked – without the radiation – just to be safe.
The tomosynthesis study, while limited as a retrospective analysis – not a randomized controlled trial, does show us that mammography is making some progress as a screening tool, and that tomosynthesis may be especially useful for those with cancer concerns following a physical breast exam.
Should You Get an Annual Mammogram?
Whether or not to get an annual mammogram – and starting at what age – is an individual decision each woman needs to make with the help of her doctor. My suggestion is that women empower themselves by learning as much as possible about mammogram screening from a variety of sources (while this article is a good place to start, it is by no means a comprehensive analysis of the issue). Know the benefits; know the risks.
The National Cancer Institute has made available online a Breast Cancer Risk Assessment Tool which may be of use in making decisions involving mammograms. In addition to mammogram screening, some techniques for early detection include (as mentioned earlier) self- and physician-conducted breast exams, ultrasound, digital mammography, magnetic resonance imaging (MRI), and thermography.
A form of infrared imaging used to detect heat, thermography can indicate the presence of inflammation, which often is present in pre-cancerous and cancerous cells; it can also be very useful in early detection of any breast abnormalities. Provided you can find a screening center that utilizes thermography, it’s my screening machine of choice.
You can also learn more about risk factors for breast cancer in younger women by visiting this Centers for Disease Control web page.
Breast Cancer Treatment is an Individual Decision
If a woman is diagnosed with breast cancer, she should learn as much as she can about it. Breast cancer certainly can be treated in a variety of ways, not just the traditional methods of surgery, chemotherapy and radiation. If she chooses to undergo conventional therapies, a woman should consider some form of alternative therapy that will compliment her healing. The decision about which therapies are right for her can be difficult – every woman needs to do her own homework and due diligence when it comes to choosing cancer treatments.
I’ve treated many women who have integrated strategies from both the conventional and alternative models, and strongly recommend Knockout, by Suzanne Somers, as referential reading. Somers’ book is a strong message to women that, when it comes to breast cancer, you’ve got to treat physical, spiritual and emotional aspects of the illness. I also personally know many of the experts in Knockout and that many of their recommended alternative therapies do work. For instance, I would send my patients with breast cancer to Dr. Stanislaw Burzynski, of the Burzynski Clinic in Houston, Texas. I also recommend Oasis of Hope centers in Irvine, California and Tijuana, Mexico. While entirely different facilities, both Burzynski Clinic and Oasis of Hope offer wonderful options for women who want either less toxic alternatives to conventional breast cancer treatment, or alternative adjunct therapies to support chemotherapy, radiation and/or surgical treatments.
Breast Cancer Prevention
The best way to fight breast cancer is to try to avoid developing it in the first place through anti-cancer lifestyle choices. In Women’s Bodies, Women’s Wisdom Board-certified OBGYN Christiane Northrup, M.D. recommends sticking to an anti-inflammatory, high-fiber diet rich in phytonutrients, cruciferous vegetables and omega-3 fats, maintaining a healthy weight, and getting enough sleep as well as moderate daily exercise to promote healthy breast tissue. Limiting consumption of alcohol and non-organic dairy products (which do not contain rGBH, a GMO product also known as bovine growth hormone) can also help women avoid excess estrogen (relative to progesterone) which may be associated with greater breast cancer risk. Other preventative measures include stress management and creating emotional health as well as supplementation with coenzyme Q10, vitamin D, melatonin, and selenium.
As a cardiologist, I’ve got to put in my two cents here and remind you all that, while cancer (generally) is the second leading cause of death in both women and men in the U.S., heart disease, unfortunately, remains the number one killer and is often overlooked as a significant women’s health issue. While breast cancer certainly deserves the attention it gets, I just want to remind you about the importance of heart disease prevention.
- The American Cancer Society (ACS) at Cancer.org:
- Centers for Disease Control and Prevention at CDC.gov:
- Cancer Among Women, accessed Oct. 8, 2013.
- Leading Causes of Death of Females in the United States, 2010 (current listing), accessed July 20, 2014.
- Breast Cancer In Young Women: Who Has A Higher Risk?, accessed July 20, 2014.
- Vital Signs: Breast Cancer, accessed Oct. 4, 2016.
- The United States Preventative Services Task Force. Screening for Breast Cancer Recommendation Statement. Uspreventativeservicestaskforce.org, November 2009, accessed July 21, 2014.
- Kolata G. “Mammograms’ Value in Cancer Fight at Issue.” The New York Times. Sept. 22, 2010.
- Miller A, et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomized screening trial. BMJ. 2014;348:g366.
- Centers for Disease Control and Prevention. Risk Factors for Breast Cancer in Young Women, accessed July 20, 2014.
- National Cancer Institute at the National Institutes of Health. Digital vs. Film Mammography in the Digital Mammographic Imaging Screening Trial (DMIST): Questions & Answers. Cancer.gov, accessed July 20, 2014.
- Friedewald SM, et al. Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography. JAMA. 2014;311(24):2499-2507.
- Northrup, C. “Best Breast Test: the Promise of Thermography.” Available at www.drnorthrup.com.
- Northrup, Christiane. Women’s Bodies, Women’s Wisdom (Bantam Books, 2006).
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